28 - Developing liaison psychiatry services

Summary

Developing clinical services is challenging. This is especially the case for liaison psychiatry where, at the time of writing, there are no direct requirements for services to exist, knowledge about the functions of liaison psychiatry is generally limited among both managers and other clinicians, and service models vary significantly. However, there have been many successful developments. This chapter aims to give an outline of how such developments may be achieved.

The chapter is based on the expansion of an existing liaison psychiatry service in an acute hospital for adults over 18 years of age in England that takes referrals from all areas of the hospital. However, the principles should apply to services in other countries, covering other ages or service models and be applicable even if there are changes in specific drivers for service development. The chapter also applies to setting up a service from scratch, although this is generally harder unless there is already considerable local demand. It should also be valuable for those needing to defend the service against cuts, although in this case it would be especially important to identify local support and areas of resistance to, or concerns about, the service and to address these in a final report.

Summaries of relevant data and successful business cases are available on the Royal College of Psychiatrists website established to support liaison psychiatry service development (www.rcpsych.ac.uk/specialties/faculties/ liaison/members/servicedevelopment.aspx). In addition, the Academy of Medical Royal Colleges document No Health without Mental Health (2009) provides the case on need and also gives specific illustrated examples of improved outcomes.

General principles of service development and stakeholder involvement

Service development is generally not a linear process and involves a series of discussions and repeated work over several years. However, for clarity, the principles will be described as if they are sequential.

The first task of service development involves engaging stakeholders by increasing their awareness and knowledge of what a liaison psychiatry service does, what clinical areas it addresses, what skills are needed in the team and how should it lead to clinical, financial or other benefits. It is important not to underestimate this work. Personal relationships and, if present, the reputation of your team's existing work are likely to be as crucial as more factual evidence in determining successful development.